[Comparison of hepatic resection and transarterial chemoembolization for hepatocellular carcinoma within the Milan criteria].

OBJECTIVE: To compare the long-term survival of hepatocellular carcinoma (HCC) patients within the Milan criteria who underwent hepatic resection (HR) or transarterial chemoembolization (TACE). METHODS: A total of 159 HR and 42 TACE patients with HCC within the Milan criteria were retrospectively evaluated. Propensity-score matching (PSM) was used to generate matched controls. Long-term survival was evaluated by the Kaplan-Meier method. And independent prognostic predictors were determined by the Cox proportional hazard model. RESULTS: After adjusting for baseline differences, 84 HR and 42 TACE patients were selected. Median survival time was 42.9 months in HR group versus 34.8 months in TACE group. The 1, 3 and 5-years survival rates were significantly higher in HR group (87.8%, 64.0%, 41.9%) than those in TACE group (85.7%, 47.6%, 26.0%; P = 0.028). Subgroup analysis showed that the patients with single-tumor HCC ≤ 5 cm had 1, 3 and 5-year overall survival rates of 86.3%, 61.3% and 42.9% after HR versus 90.3%, 61.3% and 33.2% after TACE (P = 0.332). Among those with multinodular HCC involving 2-3 tumors ≤ 3 cm, 1, 3 and 5-years survival rates were 93.8%, 75.0% and 39.3% after HR versus 72.7%, 45.5% and 9.1% after TACE (P = 0.002). Body mass index ≥ 23 kg/m(2), serum level of alpha-fetoprotein (AFP) ≥ 400 µg/L and TACE treatment significantly predicted poor survival according to the Cox proportional hazard model (all P < 0.05). CONCLUSIONS: Hepatic resection provides better long-term survival than TACE for HCC patients within the Milan Criteria. In fact, HR provides significant long-term survival benefits for patients with multinodular HCC involving 2-3 tumors ≤ 3 cm. In contrast, both HR and TACE have similar survival rates among patients with single-tumor HCC ≤ 5 cm.